Healthcare Provider Details

I. General information

NPI: 1902990443
Provider Name (Legal Business Name): FREDERICK L BALLET MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 02/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 SAGEMORE DRIVE SUITE 103
MARLTON NJ
08053
US

IV. Provider business mailing address

7000 ATRIUM WAY SUITE 6
MOUNT LAUREL NJ
08054
US

V. Phone/Fax

Practice location:
  • Phone: 856-983-4263
  • Fax: 856-983-9362
Mailing address:
  • Phone: 856-206-4500
  • Fax: 856-234-4241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMA41767
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code2086S0105X
TaxonomySurgery of the Hand (Surgery) Physician
License NumberMA41767
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: